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APHA Scientific Session and Event Listing

H. June Dagher, MPH, Janet Prvu-Bettger, PhD, Hilary Wall, MPH, and Cynthia Boddie-Willis, MD, MPH. Division of Health Promotion Disease Prevention, Massachusetts Department of Public Health, 250 Washington Street, Fourth Floor, Boston, MA 02108, 617-624-5416, june.dagher@state.ma.us

Objective: The appropriate delivery of care should be an expectation of patients regardless of where treatment is provided; yet studies have shown that the quality of care can vary widely by facility. The objective of this analysis is to describe the quality of acute stroke patient care in a sample of Massachusetts hospitals by examining the influence of hospital characteristics on adherence to four primary inpatient performance measures. Methods: Massachusetts acute care hospitals designated by the Department of Public Health with a Primary Stroke Service were eligible to participate in a state-based quality improvement program supported by the Paul Coverdell National Acute Stroke Registry. Of 72 acute hospitals in the state, 36 committed to participation in June 2005. An inventory of hospital characteristics was created including annual stroke volume, teaching status, rural classification, involvement of a neurologist in each patient's care, and use of standing orders. From July through December 2005, 36 sites recorded data in the registry on 2,625 stroke admissions. The patient population is described in relation to hospital characteristics. A logistic regression model was developed to evaluate the association of hospital characteristics with patient care defined as adherence to all four primary inpatient measures combined: a screen for dysphagia, deep vein thrombosis prophylaxis administration, lipid profile during hospitalization, and initiating antithrombotic medication within 48 hours of hospitalization. Results: Of the 2,625 patient admissions recorded in the registry, 44.0% received care at a teaching facility, 10.5% in a rural facility, and 46.1% of patients were admitted to hospitals with a stroke volume larger than 400 patients per year. Although 89.9% of stroke patients had a neurologist involved in the delivery of care, standing orders were used in only 38.3% of patients. While controlling for age and gender, patients were more likely to receive appropriate care when seen by a neurologist (OR: 17.8, p = 0.01), when standing orders were used (OR: 2.4, p < .0001), and if the hospital was classified as rural (OR: 2.6, p = 0.01). Conclusion: The delivery of care to acute stroke patients may be most influenced by modifiable hospital system characteristics such as neurologist consultation and the use of standing orders rather than characteristics that cannot be changed such as annual stroke volume, and teaching status. This suggests that adherence to inpatient acute stroke measures can be improved in Massachusetts hospitals regardless of hospital characteristics.

Learning Objectives:

• Describe the performance of a sample of MA hospitals using four acute inpatient performance measures.
• Discuss the relationship of hospital characteristics with the quality of acute stroke care.
• Articulate the similarities and differences from this study on stroke care and other national reports related to hospital characteristics and quality of care.

Presenting author's disclosure statement:

Not Answered